Melika Rafael, Author at SportsFit Physical Therapy & Fitness

Three Ways to Prevent Injury in CrossFit

When participating in CrossFit, as with any fitness regimen, there is inherent risk of injury. Currently, the evidence suggests injury risk with CrossFit is comparable to regular gym training and triathlon training, while still having lower risk than contact sports 1.With the high intensity and complex movements characteristic of CrossFit comes equally high prerequisite mobility and stability demands. To mitigate injury risk and facilitate longevity with a training regimen such as CrossFit, it is imperative to take steps to ensure these prerequisites are achieved. The following are strategies to optimize common CrossFit movements and keep you training safely.

1. Latissimus Dorsi Flexibility

The latissumis dorsi is a large shoulder and back muscle that, if tight, limits the arms ability to reach overhead and can contribute to excess strain at the shoulder. The shoulder is the most commonly injured area in CrossFit, and most often during gymnastic movements 2. Full overhead shoulder mobility is utilized in gymnastics as indicated by the findings that gymnasts typically have an average of ~10 degrees greater shoulder flexion range of motion than the general population 3. A large percentage of CrossFit movements include maximal overhead positioning of the upper extremities, whether it is with a barbell, pull-up bar, or gymnastic rings. Having the flexibility to reach these end-range positions is necessary to avoid undue strain at the shoulder. The stretch below is a great option for opening up the shoulder before any overhead movements.

1. *Notes: allow low back to be rounded while upper back arches and chest drops toward the ground; ~1min static stretch, ~1min dynamic movement in and out of stretch

2. Hip Flexion Mobility

The lumbar spine is the second most commonly injured area in CrossFit, most often during barbell lifts 2. With the deep squatting often performed in CrossFit, particularly with Olympic lifts, sufficient hip flexion mobility is required to reduce excessive strain on the low back. If squatting with external load is performed beyond the depth available at the hip, the lumbar spine is forced into a compromised flexed position, which can result in greater than 100% more pressure on the intervertebral discs and other spinal structures 4. Below are exercises to optimize hip mobility in preparation for safe squatting.

2. *notes: do not allow low back to round when pulling knee to chest; ~2min per hip

2. *notes: place feet and hips in same position as you would while squatting; maintain slight arch in back as you rock back; ~2min rocking back and forth

3. Hollow Position Stability

One of the more controversial movements in CrossFit is the “kip”. It is also one of the most common, being utilized for pull-ups, muscle-ups, and even handstand push-ups. If performed incorrectly, the kip can cause excessive lumbar spine extension, resulting in significant compressive forces at the low back as well as problems throughout the body’s kinetic chain. Abdominal exercises that promote global “bracing” of the mid-line have been shown to increase intra-abdominal pressure and improve spinal stability 5. Below is an example of a kipping-specific abdominal exercise known as “hollow holds”. Developing strength in the hollow position is essential to control the kipping motion and distribute force throughout the whole body, thus avoiding excess stress at individual joints.

3. *notes: flatten low back into the ground as you raise up; hold for 3-5 seconds; control descent back to starting position; repeat to fatigue

References:

Weisenthal, B. M., Beck, C. A., Maloney, M. D., DeHaven, K. E., & Giordano, B. D. (2014). Injury rate and patterns among CrossFit athletes. Orthopaedic Journal of Sports Medicine, 2(4), 2325967114531177.
Hak, P. T., Hodzovic, E., & Hickey, B. (2013). The nature and prevalence of injury during CrossFit training. Journal of strength and conditioning research.
Gannon, L. M., & Bird, H. A. (1999). The quantification of joint laxity in dancers and gymnasts. Journal of Sports Sciences, 17(9), 743-750.
Nachemson, A. L. (1981). Disc pressure measurements. Spine, 6(1), 93-97.
Stokes, I. A., Gardner-Morse, M. G., & Henry, S. M. (2011). Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clinical Biomechanics, 26(8), 797-803.

Back to Skateboarding!!!

Hi guys! My name is Noelle Mulligan. I am a professional stunt woman, action sports enthusiast, and regular explorer. this past October, I got into a gnarly surfing accident. I was knocked off of the wave, the board came back and deeply sliced my ankle, As well as crushed the nerves, blood vessels and muscle tissue directly below my left ankle bone. It left my foot inverted, super swollen, unable to walk, run, apart from any of my regular activities that include skateboarding, snowboarding, surfing, training for stunts, and all-around active lifestyle. After my surgery, I was referred to SportsFit Physical Therapy by my friend JJ Blaisdell, who was a physical therapist assistant at the time. She had told me about one of their doctors, Kyle Brown, who also was a skateboarding enthusiast, and an apparent wizard with ankles (I'll let you in on a secret, he is).

When I first got to physical therapy, I was in the worst of ways. I was super depressed, super sick from all of the pain meds, couldn't eat, and could barely get the energy together to put on anything besides my favorite sweatshirt that read 'sure man' in the corner with matching big gray sweatpants. I would hide underneath my hats, and the first few weeks of PT were almost unbearable. They were so painful, so frustrating, and I was completely discouraged. My PT team consists of the wonderful front desk staff, including Joslyn, who has always been so kind, skateboard legend Dr. Kyle Brown, his super sweet and funny assistant Edwin, as well as the occasional pop-in appointment with the smart and rad Dr. Lauren and JJ.

From the moment that I stepped into sports fit I was always treated with respect, kindness, understanding, and most of all compassion, when I was in such a dark space and couldn't see the end of it. My injury affected my health, my lifestyle, my job, and my ability to support myself. It was a really scary time, and I can't tell you how many times I cried underneath my hat while there, yet always met with the best care possible in a physical therapy team. Kyle was a never ending supply of encouragement and help, his knowledge and skill set with the human body and fixing it back together is unmatched, and Edwin always had a joke for me when I could barely crack a smile. And a hug whenever I feel like I couldn't do anymore reps with the monster they called 'bands'. What The SportsFit team may not know is, that during those dark days, coming in two or three days a week were the highlight of my day, sometimes they felt like the only time that I was going to get better.

I spent four months at least two days a week with my team, they even developed exercises specific for me with the skateboard, and games that I could play so I didn’t get bored. I'm officially back to skateboarding, snowboarding and yesterday I went surfing for the first time since my accident. I also recently shot a commercial where I was driving two cars that were both manual, with my injured foot being able to handle the clutch, so gratifying! I could never put into words how grateful I am for The team at sports fit physical therapy for all they have done for me in putting me back together, I definitely am no Humpty Dumpty! How could I be with such an excellent team like that? Thank you for everything. And to those just beginning this PT journey after a recent accident, have faith in yourself, you’re stronger than you know, and at sports fit you will be surrounded by the best care and team you can find, they won’t give up on you even when you feel like giving up yourself. Aloha!

B-12 Shots Available at SportsFit beginning May 2nd!

Beginning May 2rd, you can now receive your B12 shots at SportsFit.

Vitamin B12 is a water soluble essential vitamin found in seafood, red meat, eggs, dairy and fortified cereals. B12 is required for the proper function and development of the brain, nerves, blood cells and many other parts of the body. Lack of adequate intake of B12, strict vegetarian or vegan diets, digestive problems, certain types of anemia, as well as body's reduced ability to absorb vitamin B12 as we age, could cause B12 deficiency.

Symptoms of Vitamin B12 deficiency include lack of energy, depression, mood disorders, fatigue, memory failure, anemia, and low blood pressure. A B12 shot not only addresses deficiency, it is also prescribed to boost energy, as a therapy for depression, or to drive cognitive function.

The Benefits of B12 injections:

Boosts energy
Boosts metabolism
Detoxifying the body and enhancing the immune system
Mental focus
Improves mood
Improves sleep

B-12 shots will be offered for $30 Tuesday from 12:00PM to 2:30PM beginning May 2nd Call 310-878-2540 or stop by our front desk to schedule today!

Helia Naimi is a board certified pharmacist and received her Pharm.D. Degree from University of Health Sciences in 2002.

Helia's Treatment Philosophy: I believe strongly in preventive care, healthy life style and eating habits. Our body, mind and soul equally need care and attention for one to be able to have harmony, peace and health.

B-12 shots will be offered Tuesday from 12:00pm to 2:30pm beginning May 2nd for $30. Call 310-878-2540 or stop by our front desk to schedule today!

Pilates for Men at SportsFit

Pilates exercises are utilized at SportsFit for core strengthening, trunk stability, scapulothoracic stability, postural improvements, and overall strengthening. Although Pilates has been more popular among females, Pilates exercises offer several positive benefits for men as well. Here are some of the benefits specific to our male clients:

The initial sessions with our new male clients usually start by the introduction of subtle, lower resistance movements indicated for neuromuscular stability and balance versus high resistance movements men are used to with powerlifting or weight training exercises. Rather than focusing on the larger more developed muscles, Pilates exercises focus on the often neglected, local stabilizers.
Pilates exercises also help improve flexibility simultaneously while building strength. Most men are less flexible than most women. This is mostly due to the type of activities and exercises that are performed by each gender. Due to the challenge men often feel with their flexibility, when first starting a Pilates routine, most men tend to shy away from Pilates. However, at SportsFit we have found that men who stick with Pilates and continue their Pilates training beyond the initial few visits, benefit from greater rewards such as improved flexibility and posture while gaining stability and strength. This in turn helps prevent injuries such as muscle strains and reduces overall stiffness.
Because of the focus on breathing and using breath with movement a feeling of being refreshed and relaxed is accomplished after every Pilates session, leading to reduction of daily stress.
Another area of benefit for guys is that because almost all Pilates exercises use the core by activating the abdominals (transverse abdominal muscle), it helps build the foundation for stronger abdominal muscles and the achievement of six pack abs.
Finally, Since Pilates exercises strengthen the core and the pelvic floor, men who practice Pilates regularly tend to have greater control of their pelvis floor, leading to better stamina in their daily and sexual activities.

Voyage LA Article – Meet Rick Rafael of SportsFit Physical Therapy in Santa Monica

Today we'd like to introduce you to Rick Rafael.

Thanks for sharing your story with us Rick. So, let's start at the beginning and we can move on from there.

I studied biomedical engineering at the University of Southern California. Upon graduating I started to work at Accenture doing technology and process consultation to fortune 500 companies. However, a few years into my career as a consultant, I realized that my passion was in health and wellness. I therefore, decided to leave the technology field, in order to be able to apply myself in the field of health and wellness. I worked as a trainer and martial arts instructor while completing my doctorate program. After graduating as a physical therapist, I then completed a residency program at Kaiser Permanente and obtained board certification in orthopedics. After a few years of working at various clinics, I established SportsFit in 2010 with the intention of providing the highest quality of service to every patient. It is more than rewarding to hear from patients, colleagues and referring physicians that they consider SportsFit the gold standard for a physical therapy clinic and to have been recognized as a leader in our field.

Has it been a smooth road?

Many of the obstacles that I had considered prior to the inception of SportsFit proved to be less of a challenge than initially imagined. However, we ran into several other challenges and growing pains in the last 6 years. Our business plan had identified and planned for competition, marketing, resources, and equipment needed. However, managing several employees all with different backgrounds and expectations was definitely a learning process for me.

So, as you know, we're impressed with SportsFit Physical Therapy - tell our readers more, for example, what you're most proud of as a company and what sets you apart from others.

My vision for SportsFit has always been to lead a healthy and happy environment optimized for the offering of excellence in the service we offer to our patients and the positions we create for our employees. We are proud to have been able to offer more than 60,000 treatment sessions as a team. At SportsFit, most of our patients are referred by a friend or family. In many cases we have treated entire family members, whom have referred each other to SportsFit for different reasons. I consider this a huge compliment and one of the most important reasons to our success as a clinic. In an economy where insurance providers continue to raise member premiums and reduce provider reimbursements, what keeps us going is the positive feedback we receive from patients on a daily basis. To have been able to assist the recovery and healing of so many patients and leading them back to a healthy and active life is a priceless reward for all of us at SportsFit.

What sets SportsFit apart as a clinic, is the ability to offer a multidisciplinary approach to therapy by providing physical therapy interventions, including orthopedic and sports rehabilitation, Pilates, Acupuncture, therapeutic yoga, therapeutic massage, and sports performance sessions to our patients. At SportsFit, our patients are always treated by a doctor of physical therapy and receive one-on-one treatments for their entire hour long session, receiving true quality care. Our patients benefit from utilizing a 5,000sq-ft therapy and fitness facility at a state of the art clinic with the highest quality of sports & therapy equipment.

Let's touch on your thoughts about our city - what do you like the most and least?

I honestly believe that Santa Monica is one of the best cities in the world. Almost perfect weather, proximity to the beach, access to a variety of different resources, places, and events make our city a fun and exciting place to live. The main issue with a large city like Los Angeles is traffic. I believe the secret to living in LA is to live close to your work in order to limit your commute. Saving time on the daily commute makes everything else much more effortless.

Benefits and Application of Foam Rolling in Physical Therapy

Some of the goals of using a foam roller during a patient’s rehabilitation include improving performance and flexibility, reducing post exercise soreness, reduce recovery time and help alleviate muscle pain/tightness.

The term used for Foam rolling in physical therapy is “self-myofascial release”. “Fascia” refers to the connective tissue that binds muscles together. By applying pressure in the form of myofascial release using a foam roller, you help improve and guide blood circulation to the region to assist the healing process and reducing muscle tightness.

A recent study in the Journal of Sports Rehabilitation found that foam rolling coupled with static stretching could increase range of motion more than stretching alone (study was focused on the hip range of motion). Other studies have found benefits such as “less muscle soreness, better vertical leap and greater flexibility”. It has also been found that foam rolling may activate the central nervous system which registers and reacts to pain. The nervous system also regulates functions such as blood flow and heart rate. Therefore foam rolling is thought to improve arterial flexibility and vascular function.

Other benefits of foam rolling as a form of myofascial release are similar to the benefits of massage therapy such as relaxation of the nervous system through the reduction of stress hormones (i.e. cortisol).

It is suggested to use foam rolling before exercise to work on improving mobility and range of motion and to use the foam roller after exercise in order to help prevent muscle soreness.

Patient Spot Light – Get Fit for Soccer

"I came to Sportsfit immediately following my first major sports injury in the beginning of 2016. Very quickly, Dr. Rebecca Pitts, her assistant Olivia, and the rest of the team came up with fun yet challenging ways to bolster my strength and my confidence. I left every session feeling energized, more knowledgeable of my prognosis and treatment plan, well-looked out for, and of course noticing a little of that good “burn” from a workout. Soon, exercises evolved from just tensing my quads to jump squats and barbell deadlifts. I was so happy with my experience that I continued training with personal trainer Olivia outside of SportsFit after my insurance ran out. Nine months out of surgery, I am able to go on hikes and kick the ball around with friends, and see my goal of being back on the soccer field not far ahead."

~Evan Choate

How Light Therapy Works

At SportsFit, our goal is to utilize the time we have with our patients most effectively. In order to offer most optimal treatment sessions, it is vital that we utilize the time we have to apply our most effective modalities. This is why we have invested in state of the art laser and light therapy including Blue light, Infrared laser and red laser. With laser therapy, the treatment times are fast and patients see results with just 2 to 3 applications per week, with treatment times of less than 5 minutes.

The result is tissue repair, pain reduction, and accelerated resolution of inflammation. Laser Therapy has been used for more than 20 years extensively throughout the world to treat a number of soft tissue injuries, pain, and inflammatory conditions. Recently, this technology has been cleared by the FDA for the treatment of pain and stiffness associated with arthritis. Laser therapy is a safe and convenient modality especially considering issues regarding the safety of traditional arthritis and pain.

Physical Therapy for Low Back Pain Lowers Cost

The cost of treatment for patients with low back pain (LBP) has a major economic impact worldwide. According to a 2006 review¹, total costs associated with LBP in the United States exceed $100 billion per year, two-thirds of which are a result of lost wages and reduced productivity. Recent studies over health care cost indicate that the management of LBP with physical therapy can result in lower costs and use of health care resources.2 More specifically, studies show that initial referrals to physical therapy resulted in less than half the cost of imaging (MRI, usually about $1000) and generated lower costs associated with use of health care resources over time.

The authors noted that advanced imaging often 'labels' a patient's LBP that might otherwise be viewed as uncomplicated, causing heightened concern in some patients and providers, motivating them to seek additional care (opiod medications, spinal injections, surgery etc). Authors said that physical therapy may provide patients with an active approach to LBP, enhancing patients’ perceived ability to self-manage their condition. If you have low back pain, you should consider physical therapy as a starting point for care. There is growing evidence that early physical therapy results in lower health care costs for treatment and able to initiate an active home program to assist patients return back to recreational or usual activity. Most insurance companies honor “direct access” where you can seek physical therapy care without the need for a prescription from your physician.

Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences [review]. J Bone Joint Surg Am. 2006;88(suppl 2): 21-24.2. Fritz JM Brennan GP, Hunter SJ. Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Serv Res. 2015 Dec;50(6):1927-40.